Individual provider Active NPI

Mark D. Goodman, M.D.

  • Family Medicine Physician
  • Omaha, NE
National Provider Identifier
1326157124
Registry record updated Nov 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
17235 Issued in NE
Practice address
1319 Leavenworth St
Omaha, NE 68102-3215
Phone
(402) 717-0420
Fax
(402) 717-6042
NPI assigned
Aug 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 17235 NE Primary

Addresses

Primary practice location

1319 Leavenworth St
Omaha, NE 68102-3215

Mailing address

7261 Mercy Rd
Omaha, NE 68124-2311
Phone (402) 398-6254

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091118000309 NE Practitioner - Family Practice 8325186026 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Nebraska College of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alegent Creighton ClinicGroup PAC ID 1951210418, 951 clinicians

Practice addresses (Care Compare)

16909 Lakeside Hills CT
Omaha, NE 68130-4661

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Alegent Creighton Clinic Family Medicine CurrentSince Sep 1, 2012 Accepting new patients
CHI Health Clinic Physician Enterprise-Anesthesia LLC PastSince Mar 26, 2013 Accepting new patients
Creighton University Family Medicine Past Accepting new patients
Alegent Creighton Clinic Family Medicine Past Accepting new patients
Alegent Creighton Health PastSince Jun 1, 2015 Accepting new patients
Creighton University Past Accepting new patients

Locations

2771 Solution Ctr
Chicago, IL 60677

1319 Leavenworth St
Omaha, NE 68102
Phone (402) 552-2050

7261 Mercy Rd
Omaha, NE 68124
Phone (402) 398-6248

7710 Mercy Rd
Ste 426
Omaha, NE 68124
Phone (402) 343-8650

7909 N 30th St
Omaha, NE 68112
Phone (402) 280-4780

16909 Lakeside Hills Ct
Ste 401
Omaha, NE 68130
Phone (402) 827-4920

2412 Cuming St
Ste 200
Omaha, NE 68131
Phone (402) 717-0380

Interoperability endpoints

  • Direct secure messaging: mgoodman45782@achce.catholichealth.net
  • Direct secure messaging: mark.goodman.1@23757.direct.athenahealth.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478649600000",
    "number": "1326157124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7261 MERCY RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242311",
            "telephone_number": "402-398-6254",
            "fax_number": "402-829-8513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1319 LEAVENWORTH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681023215",
            "telephone_number": "402-717-0420",
            "fax_number": "402-717-6042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "MARK",
        "middle_name": "D.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2016-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "17235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.